AVILLA R-13 SCHOOL DISTRICT
P. O. Box 7
Avilla, MO 64833
(417) 246-5330
APPLICATION FOR A CERTIFICATED POSITION
The School District considers applicants for all positions without regard to race, color,
religion, sex, national origin or disability. If you have a disability or handicap, which
may require accommodation for you to participate in our application process (including
filling out this form, interviewing or any other pre-employment procedure or
requirement), please make us aware of any accommodation you feel is necessary. If you
have any inquiries, complaints or concerns about any pre-employment procedure or
requirement, including completing this application, or about the District policy of nondiscrimination, you may contact Mr. Brad Byers at 417-246-5330 or at
bbyers@avillapanthers.org.
All applicants are expected to answer all questions on this application. Answer “None”
or “Not Applicable” where necessary.
Date: __________________________
_______________________________________________________________________
Last Name
First Name
Middle Name
Other names that may appear on your transcripts or records:
_______________________________________________________________________
Social Security Number: ______-______-_________
Current Address: _________________________________________________________
Street
City
State
Zip
Current Phone: (______) _______-__________
Permanent Address: _______________________________________________________
Street
City
State
Zip
Permanent Phone: (______) _______-__________
Date Available: ________________________________
Certification: Type ___________________ (Life, PC1, Etc.) Other _________________
State(s) ____________________________ Subject(s) ____________________________
Grade Level(s) ______________________ Expiration Date(s) ______________________
Other information regarding your certification and/or certification status: _____________
________________________________________________________________________
Position(s) for which you are applying: ________________________________________
Subjects(s) _______________________________________________________________
Grade Level(s) ___________________________________________________________
Are you available for substitute teaching? ________ Paraprofessional? ______________
Extra duty positions you may be interested in sponsoring or coaching? _______________
________________________________________________________________________
Educational Preparation:
Name &
Location
High
School
Colleges/
Universities
Dates of
Attendance
N/A
Name of
Degree
N/A
Major
N/A
Overall GPA
N/A
Teaching Experience (If none, list student teaching experience):
District
Name &
Location
Position
Dates of
Employment
Number of
Years
Supervisor
Phone
Dates of
Employment
Number of
Years
Supervisor
Phone
Other Work Experience:
Employer
Name &
Location
Position
References:
Name
Address
Employment Questions:
Phone
Position
1. Have you ever been arrested for, or charged with or convicted of a felony or
misdemeanor? (Exclude traffic offenses for which you were not sentenced to jail
or for which the fine was less than $100.00) ______________________________
2. Have you ever pleaded guilty or no contest to a felony or misdemeanor? (Exclude
traffic offenses for which you were not sentenced to jail or for which the fine was
less than $100.00) __________________________________________________
3. Has the Missouri Division of Family Services or a similar agency in any other
state or jurisdiction, ever issued a determination or finding of cause or reason to
believe or suspect that you have engaged in physical, emotional, psychological or
sexual abuse or neglect of a child? _____________________________________
4. Have you ever failed to be re-employed by a educational institution? __________
If the answer to any of the foregoing questions is “yes” please explain; use a separate
sheet if necessary:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
READ CAREFULLY BEFORE SIGNING
I acknowledge and agree to the following provisions as conditions to consideration of
my application for employment:
1. I hereby authorize my current and former employers and references to furnish any
information about me and about my work experience. I release my current and
former employers and references from any and all liabilities or damages of any
nature as a result of providing such information. My current and former
employers and references may rely on a signed copy of the release.
2. I understand and consent to having a criminal and arrest records checks as well as
background checks by the Missouri Division of Family Services as a condition for
consideration of my application for employment.
3. I certify that the answers given in this application are true and complete to the
very best of my knowledge. In the event I am employed by the District and in the
further event that I have provided false or misleading information in the
application or in subsequent employment interviews, I understand that my
employment may be terminated at any time after discovery of the false or
misleading information.
4. I understand that this application will be considered active for 1 year. I
understand that if I wish my candidacy to remain open after that date I must
submit another application.
________________________________________
Signature
____________________________
Date
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Do Not Write Below This Line – For Administrative Use Only
Date received: Application _________ Credentials __________ Transcripts _________
Date interviewed: ________________
Interviewed by: __________________________
Date and time: Applicant notified ____________________________________________
Date and time: Applicant accepted ___________________________________________
Position offered: __________________________________________________________
Salary step and level: ______________________________________________________
APPLICANT QUESTIONS
Name: ______________________________________ Social Security#: ____-___-_____
Please respond to the following questions in your own handwriting.
1. Why have you chosen teaching as your profession?
2. What student outcomes would you strive for as a teacher?
3. Write a brief autobiography focusing on the important people and events in your
life.